EHR Benefits: A Macro and a Micro View

The New York Times ran a short piece by Steve Lohr yesterday that highlighted a new study led by two doctors from Massachusetts General Hospital.

The study compared 3,000 hospitals at various stages of implementing and using electronic health records (EHRs). For those who see EHRs as a panacea for the healthcare system, the initial findings are disappointing. To quote from Lohr’s story: “In the heart failure category, for example, the hospitals with advanced electronic records met best-practice standards 87.8 percent of the time; those with basic computer records, 86.7 percent; and those without, 85.9 percent. The differences in other categories were similarly slender.

“Reducing the length of hospital stays, according to many experts, should be a big money-saving payoff from electronic health records — as better care aided by technology translates into less time spent in hospitals. For hospitals with full-featured digital records, the average length of stay was 5.5 days; for those with basic computer records, 5.7 days; and those without, 5.7 days. The differences, Dr. Jha said, were ‘really, really marginal.’”

So, at least by these two measures the return on the use of EHRs so far is pretty meager. But, as the study authors point out, the evidence for gains from EHRs so far has come from an “elite” group of high-performing providers that have spent years adapting to the technology. No surprise, with just 20 percent of U.S. physicians now using computerized health records (and less than 5 percent in very small practice groups) there’s a long way to go to meet the federal EHR usage goals, despite the financial incentives in the HITECH portion of the 2009 ARRA stimulus package.

That’s a macro view. But if you take a micro view, there are some stunning successes in the use of EHRs to improve physicians’ practice operations and patient care. Twice this year I’ve had the pleasure of seeing a presentation by Dr. Jim Morrow, formerly of the North Fulton Family Medicine Center. Dr. Morrow presented at HIMSS 2009 in Chicago, and a few weeks ago he presented at the HIMSS and Massachusetts Health Data Consortium Healthmart 09 conference in Worcester. Massachusetts. Morrow is a compelling presenter and he tells a detailed story about his small medical practice group implementing and using EHR technology, going back almost 10 years. Here are his slides.

To summarize some of the ROI from his four-physician practice:

Transcription costs dropped from $110,000/year to zero

Chart handling dropped from $30,000/year to zero

Chart searches dropped from $16,000/year to zero

Dictation dropped from $32,000/year to zero

Reduced cost per patient visit from $112 to $79

Full time employees per provider dropped from 4.7 to 2.8

Morrow estimates that EHR technology saved the practice 11,440 billable staff hours per year, which could go into serving more patients. His presentation has some compelling images of unreadable handwritten prescriptions next to clear, legible e-prescriptions – a key part of reducing medical errors.

Now, none of this is new. EHR vendors, HHS officials, Dr. David Blumenthal and many others have been pushing for widespread EHR adoption for years. And it’s not that surprising that a study would find that so far the measureable benefits are not compelling across the entire U.S. hospital system. But EHRs will help transform healthcare and it’s only a matter of time.

This study is like taking a snapshot of internet-enabled e-commerce in 1996. What looked like hype back then is now a critical underpinning of our economy. Many people have invoked the so-called Metcalfe’s Law (ie.: the value of the network is proportional to the square of the number of users) first postulated about communications networks, as something that will come into play as EHR usage reaches critical mass. Let’s hope that’s the case, and the findings of this new Mass General study are simply a realistic progress check.